Using
fresh whole blood from single donors is better than using component blood from
multiple donors in pediatric heart surgery patients, according to an article in
the May 2015 issue of The
Annals of Thoracic Surgery.

Key points

Fresh whole blood reduces the number of individual blood donors that pediatric heart patients are exposed to, which reduces the risk of acquiring transfusion-related illness.

Study results show the youngest patients having complex procedures were exposed to the highest number of donors, while older patients having simpler procedures were exposed to the fewest.

The researchers said their findings should prompt officials to re-examine current blood storage practice and make whole blood more readily available for pediatric patients.

Patients receiving blood or blood
components face allergic and febrile (having symptoms of a fever) reactions, as
well as serious complications such as lung injury and infectious disease.

“The risk for disease transmission
in pediatric patients is essentially the same as the risk for adults, but may
be more costly over the long term because infants and young children may live
longer with chronic illness stemming from transfusion,” said David R. Jobes,
MD, from The Children’s Hospital of Philadelphia and Perelman School of
Medicine at the University of Pennsylvania, who led the study.

Dr. Jobes and colleagues examined
the effectiveness of a program at The Children’s Hospital that was intended to
reduce transfusion by using a standard order of two units of fresh whole blood
for elective cardiac surgery in patients 2 years of age or younger. As defined
in the study, fresh whole blood has not been separated into individual
components (red blood cells, platelets, plasma) and was collected less than 48
hours prior to being used in surgery.

“Currently, whole blood is not
generally made available to hospitals for use in pediatric heart surgery,” said
Dr. Jobes. “Blood centers separate donated blood into component parts which are
then stored for use in medical transfusions as needed.”

The researchers analyzed surgical
registry data and blood bank records from 1995 to 2010 on 4,111 patients; fresh
whole blood was available for 3,836 patients, while 252 received only blood
components when no whole blood was available. The median age of the study
patients was 94 days.

They found that the youngest
patients who had complex heart surgery procedures were exposed to the highest
number of donors, while older patients who had simpler heart surgery procedures
were exposed to the fewest number of donors.

“Many congenital heart conditions
require multiple surgeries over a lifetime necessitating additional
transfusion, and previous exposure can cause cross-match incompatibility,
reducing the availability of suitable blood for transfusion and cause problems
later if heart transplantation is necessary,” said Dr. Jobes. “We hope that our
research helps to re-examine current blood storage practice and make whole
blood more readily available for pediatric patients.”

Reducing the Risk of Transfusion
ReactionsIn an invited commentary in the
same issue of The Annals, Julie
Cleuziou, MD, from the German Heart Center in Munich emphasized the importance
of the findings noting, “the risk of possible life-threatening transfusion
reactions is dependent on the number of donors patients are exposed to, which
is the endpoint of this study by Jobes et al.”

“The paper demonstrates very nicely
that using fresh whole blood reduces the number of blood donors that patients
are exposed to compared to the use of blood components as stated in previous
research,” said Dr. Cleuziou. “Use of fresh whole blood in pediatric surgery,
however, will be dependent upon the cooperation and meticulous communication
between the blood center and the surgical team to ensure the blood meets all necessary
requirements.”

Full text of the article is available to credentialed
journalists upon request; contact Cassie McNulty cmcnulty@sts.org at +1 312 202 5865

About The Annals
of Thoracic SurgeryThe Annals of Thoracic Surgery is the official journal of
STS and the Southern Thoracic Surgical Association. Founded in 1964, The
Society of Thoracic Surgeons is a not-for-profit organization representing more
than 6,800 cardiothoracic surgeons, researchers, and allied health care professionals
worldwide who are dedicated to ensuring the best possible outcomes for
surgeries of the heart, lung, and esophagus, as well as other surgical
procedures within the chest. The Society’s mission is to enhance the ability of
cardiothoracic surgeons to provide the highest quality patient care through
education, research, and advocacy. www.annalsthoracicsurgery.org

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